PHYSIO-graphy

Hello! welcome to my page PHYSIO-graphy. I am Priyanshu Das, student of physiotherapy.

Operating as usual

28/04/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #66
MALUNITED FRACTURE SHAFT OF FEMUR

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 34 Years/Male

𝘾/𝙤.
•deformity and shortening of ( L) thigh following native treatment of fracture of (L) thigh bone 12 months back
•Difficulty in flexion of (L) knee and squatting for past 8 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Sustained injury to (L) thigh 12 months back following a fall – treated natively with bandage for 4 months.Now has found that (L) leg is shorter than right and is externally rotated- with difficulty in flexion and squatting
•No H/o. instability
•No H/o. swelling or sinus with
discharge

𝙊/𝙀 :
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•(L) Thigh– wasting, (L) leg, and patella externally rotated than right (L) Lower limb shortening +
•No sinus or Scar

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•Bony swelling and irregularity in M/3 (L) femur
•No abnormal mobility or crepitus •External rotation deformity of (L) leg - 15° Shortening of 4 cm + in femoral component

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
•flexion : 0°- 1 10°
•IR: 15° - further rotation of 10º
IR: Correctable to neutral position

𝙂𝙖𝙞𝙩- Short Leg Gait

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
X-Ray : Malunited # Shaft of femur M/3

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Malunions of femoral shaft are not uncommon
2. Most often occurs after treatment with cast braces or treatment of unstable open # with small intramedullary nails
3. Almost all malunions of shaft show combined deformities of malrotation, angulation and shortening
4. Shortening more than 2.5 cm , malrotation of 10°-15° and angulation of 15° requires correction in active patients
5. The type of surgical procedure indicated for correction of malunion of the femur depends on the degree of deformity, the alignment of medullary canal and the location of deformity












Photos from PHYSIO-graphy's post 23/04/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #65

AVASCULAR NECROSIS OF HIP

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 34 Years/Female

𝘾𝙡𝙤.
pain in the left groin, progressively restricted movements with limp in (L) hip for past 6 months

𝙃/𝙤.
known case of skin disease for which she is on steroid therapy for the past 1 year

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
Pain : Gradual in onset, progressive, deep throbbing, worse on ambulation

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•No H/o. trauma/constitutional symptoms •Not a smoker/alcoholic
•No H/o. renal/liver disease
•On intermittent high dose steroid therapy for skin disease for the past 1 year.

𝙀𝙭𝙖𝙢𝙞𝙣𝙖𝙩𝙞𝙤𝙣
•Tenderness in Scarpa's triangle
•ROM-restricted in all directions with pain more in abduction and internal rotation
•No limb length discrepancy/ distal neurovascular deficit •Trendelenberg gait

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
•X-Ray (L) Hip increase in density in the superior portion of (L) femoral head with crescent shaped radiodense zone in subchondral area decreased joint space

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Uncommon condition; 3rd/4th decade; M:F: 4:1, often B/L
2. Characterized by development of an area of bone necrosis in wt. bearing portion of femoral head
3. Cause is unknown (idiopathic) in most cases, but they may be seen in association with gouty arthritis, chronic alcoholism, chronic renal disease and long term steroid therapy
4. After initial infarction, collapse and fragmentation may be seen, which leads to deformity of the femoral head and degenerative arthritis
5. Radiographic staging (Ficat and Arlet) Stage 1: Trabeculae normal Stage 2 : Sclerosis of trabeculae
Stage 3 : Loss of spherical shape of femoral head Stage 4 : Collapse and cartilage destruction

𝙏𝙧𝙚𝙖𝙩𝙢𝙚𝙣𝙩
Depends on stage and cause of disease Ranges from core decompression to 𝙖𝙧𝙩𝙝𝙧𝙤𝙥𝙡𝙖𝙨𝙩𝙮













16/04/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #64

FIBROSARCOMA

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 44 Years/Male

𝘾𝙡𝙤.
•pain just above (L) knee - past 6 months
•Swelling above (L) knee : past 2 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Pain initially mild, gradually progressive, limiting weight bearing and walking, now continuous
•Night cries +
•Swelling - diffuse, increasing in size of (L) thigh
•Associated with limitations of movements of knee
•No H/o. trauma / constitutional symptoms
•No H/o. family members with similar complaints

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Diffuse swelling in the distal aspect of (L) thigh
•Effusion of (L) knee +
•No sinus / scars / dilated veins

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•Warmth +/ tenderness +
•Diffuse swelling - margins ill-defined
•Firm to hard in consistency - irregularity of distal femur +, synovial effusion +
•No DNVD

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
ROM of (L) knee limited due to pain flexion 10°- 90º

𝙈𝙚𝙖𝙨𝙪𝙧𝙚𝙢𝙚𝙣𝙩𝙨
6 cm increase in the circumference of (L) thigh when compared to right

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
X-ray (L) Thigh AP / Lat = Eccentric osteolytic lesion in the metaphysis of (L) femur with absence of calcification and periosteal new bone formation suggestive of
fibrosarcoma

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Fibrosarcoma is a rare malignancy, characterized by proliferation of spindle cells without any discoverable matrix production
2 Occurs in II nd to VI th decade : male = female
3. Commonly occur in distal femur or proximal tibial metaphysis
4. Present with pain and pathological fracture
5. No pathognomic radiographic features for fibrosarcoma
6. Treatment of choice is wide surgical resection.
7. Radiotherapy may be palliative









12/04/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #63

SIMPLE BONE CYST

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 14 Years/Male

𝘾𝙡𝙤.
pain and inability to move (L) upper limb following a trivial trauma - 1 day back

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Apparently normal 1 day back, sustained a trivial trauma to (L) arm in the form of a twisting force
•Could not lift his arm - associated with severe pain on attempted movement
•No H/o. previous pain / swelling •No H/o. constitutional symptoms

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣 :
(L) arm
•No swelling No scars / sinuses
•No deformity / obvious clinical abnormality
•Movements restricted due to pain

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•Tenderness +
•Crepitus +/ abnormal mobility + in (L) upper arm Irregularity / discontinuity felt in proximal humerus
•No regional lymphadenopathy
•No DNVD

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
Severely restricted due to pain

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
X-ray (L) shoulder with arm (AP):
a) Radiolucent defect in the proximal metaphysis of the humerus + b) Fallen fragment +
c) No cortical / epiphyseal erosion

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Simple bone eyst - solitary unilocular cavity which arises near the growth plate in the metaphyseal region
2. Hitology - unknown. "Synovial arrest" thesis is implicated 3 90% occur in Ist decade : Male to female ratio :2:1
4. Proximal ends of humerus and femur are most common sites. Rarely they occur in vertebrae and flat bones
5. "Fallen leaf" sign in radiography is confirmation of diagnosis
6. Intracavitory steroid injection and curettage & bone grafting are the available treatment options









06/04/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #62

NEUROFIBROMATOSIS

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 23 Years/Male

𝘾/𝙤.
Abnormal thickening of skin over (R) shoulder with sideways bending of back (dorsal spine) - past 6 years

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Apparently normal 6 years back
•Developed skin abnormality with over growth over (R) shoulder which is gradually increasing in size
•Has abnormal / bend in the back - also progressive
•No H/o. trauma
•No H/o. constitutional symptoms

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Multiple café-au-lait spots in the body
•Plexiform neurofibromatous thickening of (R) shoulder
•Dorsal scoliosis to left with rib hump +
•Forward bending makes the curve more obvious

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•Deviation of midline of spinous process to left
•Dorsal scoliosis with rib hump (+) •Secondary compensatory curves + •Plumb - line test : balance +

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
•Fixed scoliosis – bend prominent on flexion
•No distal neurovascular deficits

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
Xray - Dorsal Spine (PA) -Cobb's angle of 40° with apex at D6

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Neurofibromatosis is a single gene disorder - two types are
i) NF -1:(Von Recklinghausen's Disease) in chromosome 17
ii) NF-2: chromosome 21

2. Clinical presentation include multiple skin patches - café au lait spots, neurofibromata and neuroma

3. Orthopaedic manifestations include dystrophies, spinal deformities, scoliosis and congenital tibial dysplasia and pseudoarthrosis

Photos from PHYSIO-graphy's post 01/04/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #61

INFANTILE QUADRICEPS FIBROSIS WITH KNEE STIFFNESS

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 6 Years/Male

𝘾𝙡𝙤.
•dificulty to squat and inability to flex the right knee since childhood

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•First born male child of non consanguinous marriage
•Had severe neonatal jaundice and septicemia at infancy, treated with injections and ICU care
•Noticed to have difficulty in squatting 3 years back; progressively worsening Now walks with limp due to straight right knee
•No H/o. trauma

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Gross wasting of (R) thigh muscles + Absence of creases over (R) knee

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•(R) Patella smaller than left and migrated proximally
•No limb length discrepancy

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
•Flexion -0- 30°
•Extension 0° - 10°
•No abnormal mobility / instability

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
•X-Ray Rt. Knee - AP & Lat: Smaller patella
•Flattening of femoral condyle

𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙨
Infantile Quadriceps Fibrosis

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙥𝙤𝙞𝙣𝙩𝙨
-Acquired extension of knee in children is the result of repeated intramuscular injections into thigh muscles
-In infancy this combined with poor nutrition and severe underlying disease leads to muscle necrosis followed by fibrosis and adhesion to underlying structures and covering deep fascia with failure of muscle development
-Physiotherapy and passive stretching is unlikely to lengthen the contracted tissues Surgical lengthening of the extension apparatus is always necessary which is achieved by lengthening the quadriceps tendon distally or by relcasing the shortened muscles from their proximal attachments











Photos from PHYSIO-graphy's post 28/03/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #60

DISLOCATION OF PATELLA (RECURRENT)

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 40 Years/Male

𝘾/𝙤.
•pain in the right knee joint with feeling of giving way
•Patient sustained violent dislocation of the right patella - 2 years back following which patient has had 4 episodes of dislocation associated with pain

•𝙊/𝙀
Attitude at Rt. Lower Limb- Extension at hip and knee and neutral at ankle joint

𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Muscle wasting of the right thigh
•No scars/sinuses
•No deformity

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•No warmth
•No bony / soft tissue tenderness
•No joint line tenderness

𝙎𝙥𝙚𝙘𝙞𝙖𝙡 𝙩𝙚𝙨𝙩𝙨:
1) Apprehension test (+ve) (Examiner holds the relaxed knee in 20 – 30 degrees of flexion and manually subluxes the patella laterally. When the test is positive, the patient suddenly complains of pain and resists any further lateral motion of the patella)
2) Patellar maltracking + Q- angle 15 degree (increased) No distal neuro vascular deficit

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
•Flexion 0- 100 degree - no pain
•Extension : Full but extensor lag for the last 10 degree (+)

𝙈𝙚𝙖𝙨𝙪𝙧𝙚𝙢𝙚𝙣𝙩𝙨
•No shortening
•X-ray Right knee with AP/Lateral – No bony abnormality
•Insall index- normal (length of patellar tendon (LT) and the diagonal length of the patella (LP) have a ratio of 1:0. Patella alta is likely to be present if LT exceeds LP by more than 20%)
•Axial view of Patella - subluxation of right patella











25/03/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #59

ANKYLOSIS KNEE - SEPTIC ARTHRITIS SEQUALAE

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 40 Years/Male

𝘾/𝙤.
•inability to bend (R) knee- past 8 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Gives H/o. painful (R) knee with gradual restriction of flexion since past 8 months

•Pain gradually subsided with increasing inability to bend (R) knee Now cannot bend the knee which limits his daily activities

•No H/o. trauma

𝙊/𝙀:
(R) Knee Inspection

•No swelling / sinus / scars Atrophy of muscle of thigh & leg No limb length discrepancy
•Deformity (+) 10° flexion and ext rotation
•Palpation & Movements Not tender / or warm
•Deformity - fixed flexion - 10° Further flexion – 50– 10º
•No other movements possible •Movements elicit pain
•No distal neurovascular deficit
•X-ray (R) Knee - AP / Lat decreased joint space with erosion of articular surface

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Bony / fibrous ankylosis is a complication of septic arthritis due to cartilage destruction
2. If the ankylosis is sound with no pain and in functional position (10° flexion 10° ext. rotation) it can be left alone
3. Unsound ankylosis / in unsound position will require surgical arthrodesis










Photos from PHYSIO-graphy's post 21/03/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #58

SEMI MEMBRANOSUS BURSITIS

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 40 Years/Male
(Farmer by occupation)

𝘾𝙡𝙤.
•pain and swelling in the inner posterior aspect of (R) knee joint for the past 6 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Swelling noticed in the medial and posterior aspect of knee 6 months back, gradually increasing in size
•Associated with vague pain and limitation of extension
•No H/o. trauma/ constitutional symptoms
•No H/o. other joint involvement /regional lymphadenopathy

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Diffuse 2x4cm swelling+in postero medial aspect of (R) knee just above the joint crease
•More prominent on extension of knee, flaccid on flexion
•No superficial dilated veins/scars

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•No tenderness, fluctuant tense swelling which is mobile
•Overlying skin is not adherent Not pulsatile
•No regional lymphdenopathy

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
•Flexion 0- 120° /Extension 0 - 5° / •Extension painful

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Bursae are sacs lined with membrane similar to synovium located over joints and bony prominences which function to reduce friction and protect delicate structures from pressure
2.Numerous bursae have been described in relation to hamstrings and medial gastrocnemius, the most important of which is situated between the medial head and semimembranosus muscle
3. These bursae often form a composite bursa designated the gastrocnemio-semi membranosus bursa which often communicate with the knee joint through an opening in the posterior capsule
4. It becomes inflammed especially in males who are active labourers such as game keepers, shepards and farmers
5. The bursa is superficially based and is attached to areolar tissue. Deeply it fuses intimately with semi membransus tendon
6. Important D/D include Hemangioma, neoplasms and popliteal cyst (Morant Bakers)
7. The treatment when the patient has symptoms is surgical excision of the sac.










Photos from PHYSIO-graphy's post 14/03/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #57

Prepatellar Bursitis (Housemaid's Knee)

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 33 Years/Male

𝘾/𝙤.
Unskilled labourer C/o. pain over the left knee, past 3 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Pain and occasional swelling on and off for the past 3 months over (L) knee
•No H/o. trauma/constitutional

𝙨𝙮𝙢𝙥𝙩𝙤𝙢𝙨
•Pain aggravated by working, by kneeling down (as in cleaning the floor) and relieved by rest and tablets
•No H/o. similar episodes before No H/o. other joint involvement

𝙊/𝙀
•Swelling+ in the (L) knee - upper half of patellar tendon Tender, fluctuant, no warmth Skin not adherent
•Becomes more prominent on bending the knee ROM - full / painful at extreme flexion

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
•X-ray (L) knee : No abnormality
•Aspiration : Clear, straw coloured, viscous fluid +

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Bursae are sacs lined with membrane similar to synovium located over joints and bone prominences to reduce friction and protect delicate structures from pressure
2. Prepatellar bursa is subcutaneous, present in 90% of people covering lower half of patella and upper half of patellar tendon
3. Chronic inflammation of their bursa occurs as a result of repeated trauma as in kneeling - eg housemaid, carpet layers
4. The walls becomes thickened and the interior is loculated by irregular adhesions and septa with occasional loose bodies
5. Important DD include jumper's knee and rarcly osteomyelitis and tuberculosis of patella
6. The treatment of acute bursitis is rest. The fluid may be aspirated and in small non infected bursitis l or 2ml of local hydrocortisone may be injected to relieve inflammation
7. Chronic inflammation requires complete excision of the sac through a transverse incision










Photos from PHYSIO-graphy's post 07/03/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #56

LOOSE BODIES IN THE KNEE

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 22 Years - Athlete

𝘾/𝙤. recurrent momentary locking of (R) knee followed by sweling past 3 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Apparently normal 3 months back
Started to have pain with swelling of Rt knee which subsided on rest

•Now past 1 month had 3 episodes of sudden locking of the joint, accompanied by sharp pain and followed by effusion

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
Right knee held in mild flexion Swelling (+)

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•No specific area of tenderness •Moderate effusion (+)
•No ligamentous instability

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
•Flexion 5 to 110 degree Extensor lag (+)

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣
X-ray (R) Knee : Rt Knee effusion with multiple loose bodies (intra-articular)

The commonest causes are
1. Osteochondritis dissecans (1 to 3 loose bodies)
2. Osteoarthritis (1 to 10 loose bodies)
3. Chip fracture of bone (1 to 3 loose bodies)
4. Synovial chondromatosis (50 to 100 loose bodies)

Treatment is surgical removal and subtotal synovectomy depending upon the cause

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
Intra-articular loose bodies may be derived from bone, cartilage or synovial membrane. They may be entirely free within the joint or they may retain a pedicle of soft tissue.







29/02/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #55

MENISCAL CYST

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 20 Years/Male

𝘾𝙡𝙤.
pain and swelling in the outer side of (L)knee for the past 6 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Apparently normal 6 months back, when he sustained an injury to (L) knee while playing
•Noticed a swelling in the outer side of (L) knee, accompanied by aching pain, aggravated by knee bending
•No H/o. instability/giving way of knee joint
•No H/o. other joint pains/ fever

𝙊/𝙀
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Small 1x1cm swelling in lateral side of (L) knee
•No associated swellings/scars/sinus
•Becomes more prominent when the knee is flexed at 45"-50"

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣
•No joint line tenderness / effusion
•Firm tender swelling 1x1.5cm, disappearing on flexion of knee
•No instability of knee Mc Murray test (Lt)
•No regional lymphadenopathy

𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
ROM of (L) knee are full but with pain during middle range

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
X-ray (L) Knee: Increased joint space in lateral compartment MRI (L) Knee: Cyst of the lateral meniscus

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Cystic swellings in relation to lateral meniscus are not uncommon but are rare in medial meniscus
2. Their etiology is disputed but trauma and degeneration is often implicated
3. They may remain entirely within the capsule or project through collateral ligament. There may be associated meniscal tear
4. Treatment ranges from arthroscopic excision of cyst alone to partial meniscal excision and repair and open total meniscectomy

25/02/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #54

Post Traumatic Ankylosed Ankle

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 40 Years/Male

𝘾/𝙤.Pain and immobility of (Rt) ankle past 11 months

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
•Sustained a trauma 11 months to the Rt foot, treated natively in the form of splintages for 3 months
•After the treatment, he was able to walk but with pain
•Pain was gradually progressive, limiting his daily activities, associated with swelling
•Now has severe pain with immobility of Rt ankle with limp

𝙍𝙩 𝘼𝙣𝙠𝙡𝙚 𝙊/𝙀.
𝙄𝙣𝙨𝙥𝙚𝙘𝙩𝙞𝙤𝙣
•Foot in 10° - further flexion of 5° •Inversion and eversion possible with pain

𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣
X-ray Rt ankle -AP/Lat
a) Healed malunited ankle mortice fracture with 2° OA
b) Decreased joint space with subchondral sclerosis

𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙨
Post traumatic ankylosis of Rt ankle

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Trauma is the commonest cause of 2° OA of ankle
2. Painful arthritis of ankle - surgical treatment is the mainstay - surgical ankylosis or in select cases, joint replacement

21/02/2024

𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙖𝙨𝙚 𝙨𝙩𝙪𝙙𝙮 #53

LOBSTER FOOT

𝙎𝙪𝙗𝙟𝙚𝙘𝙩- 4 Years/Male

𝘾/𝙤.
Brought with C/o. deformity of B/L foot (foot with 2 large toes) since birth

𝙃𝙞𝙨𝙩𝙤𝙧𝙮
2nd born, Full term normal vaginal delivery to non-consanguinous parents Noticed to have bilateral foot deformity with only two abnormal and large toes (digits)

𝙃/𝙤
No history of other associated congenital deformity

𝙋𝙖𝙡𝙥𝙖𝙩𝙞𝙤𝙣 𝙖𝙣𝙙 𝙈𝙤𝙫𝙚𝙢𝙚𝙣𝙩𝙨
Functionally, movements are possible though restricted Joints are supple

𝙍𝙖𝙙𝙞𝙤𝙡𝙤𝙜𝙞𝙘𝙖𝙡 𝙛𝙞𝙣𝙙𝙞𝙣𝙜𝙨
•X-ray B/L foot AP/ Oblique : B/L IInd, IIIrd metatarsals are absent
•Abnormal tarsal bones

𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙨
Bilateral partial adactyly

𝙄𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩 𝙋𝙤𝙞𝙣𝙩𝙨
1. Lobster foot is an anomaly with single defect
2. The deformity varies in degree and type
3. The first and fifth ray are usually present
4. Classified on the basis of number of metatarsal bones
5. Surgery is aimed to improve function and appearance through various soft tissue and bony procedures

18/02/2024

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

This X-ray shows a small apical left sided pneumothorax and old fractures of the left clavicle, coracoid and 5th and 6th ribs. The cause of the pneumothorax is not visible. I would like to request a PA chest X-ray for further assessment of the pneumothorax and to look for any acute rib fractures. Additionally, I would like to review a second view of the left shoulder to ensure there is no dislocation.

14/02/2024

A 57 year old man was knocked off his bicycle by a car. He developed pain
around his left shoulder and rib cage and felt winded. He was brought to emergency department by
ambulance. He is tender around the left shoulder girdle but able to move his arm. An X-ray of his shoulder has been performed.

What is your diagnosis?
Comment below⬇

11/02/2024

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

This X-ray demonstrates a left slipped upper femoral epiphysis. The right upper femoral epiphysis appears
normal. The patient should be referred to orthopaedics as it will require operative fixation. The right hip may be prophylactically fixed at the same time

06/02/2024

An 11 year old girl presents with progressive left hip pain and a limp which has
worsened over the last few days. She is systemically well, with no fever, but is
finding it painful to weight bear. A pelvic X-ray is performed.

What are your findings?
Comment below⬇

28/01/2024

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙩𝙝𝙚 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

These X-rays show a posterior shoulder dislocation.
An attempt should be made to relocate the shoulder under sedation. A post reduction X-ray is needed to assess the relocation and identify any fractures.

26/01/2024

A 37 year old epileptic woman has been brought into orthopedic department following a seizure.
She is complaining of pain in her right shoulder. She is unable to move the shoulder.
You request X-rays for further assessment.

What are your findings?
Comment below⬇

23/01/2024

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

These X-rays show a displaced pathological fracture of the right shaft of the femur. An attempt
at reducing and splinting the fracture should be made under sedation. Adequate analgesia should be prescribed. Further X-rays of the entire femur will be required to look for further bone lesions prior to surgical fixation.Given the age of the patient, the underlying bone lesion is most likely a metastasis, with the two most likely primaries in a female being breast and lung cancer. The patient will require a full history and examination,
including a breast exam, routine bloods and a chest X-ray. Further imaging
will be guided by the above but will likely involve a CT for staging.

19/01/2024

A 62 year old woman fell whilst shopping, injuring her right leg. She is very sore in the mid shaft of her right leg and unable to weight bear. She has been brought into emergency by ambulance. She is very tender on palpation of the right thigh and unable to move the leg. There is no any sign of distal neurovascular deficit. X-rays of the right femur have been performed.

What is your diagnosis?
Comment below⬇

14/01/2024

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

The X-ray shows a bilateral, symmetrical erosive arthropathy predominantly involving the metacarpophalangeal
joints. The differential diagnoses for an erosive arthropathy include psoriatic arthritis, Reiter’s syndrome and gout, however, the radiographic appearances are typical of rheumatoid arthritis.

11/01/2024

This is a X-ray of 60 year old lady’s hands. She has had painful and sore hands for several years and is struggling to perform
activities of daily living.

What are your findings?
Comment below⬇

07/01/2024

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

This lateral X-ray shows a minimally displaced fracture at the base of the 5th metatarsal. This is in keeping with an avulsion fracture (at the peroneus brevis tendon insertion site).

It requires further assessment on formal foot X-rays. I would also like to assess the AP ankle X-ray
to complete my assessment of the
ankle. Treatment of this type of fracture usually involves fitting a walking boot and referring the patient to the fracture clinic.

04/01/2024

A 29 year old man was playing tennis when he sustained an inversion injury and presented to OPD with a painful right ankle and foot. The lateral view of his ankle X-ray is shown below.

Comment your finding...
Follow us for more


Photos from PHYSIO-graphy's post 31/12/2023

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩

• These are lateral and frontal X-rays of the
right elbow of a skeletally mature patient.
• There are no patient identifiable data on the
X-rays. Confirmation of the patient’s nameand date of birth, and the date and time whenthe X-rays were performed is required beforemaking any further assessment.
• The X-rays are technically adequate with no important areas cut off.
• There is normal alignment of the elbow joint.
• No fracture or joint effusion is visible.
• No areas of bone destruction, lucency or
abnormal bone texture.
• The soft tissues are unremarkable.

In summery
These X-rays show a normal right elbow with
no evidence of a fracture,
effusion or dislocation.

Photos from PHYSIO-graphy's post 30/12/2023

A 42 year old woman fell off her bike, landing on her right elbow. It is tender on palpation, with a reduced range of movement. X-rays of the elbow have been performed.

What could be the diagnosis?
What is your finding?

29/12/2023

𝙍𝙚𝙛𝙛𝙚𝙧 𝙩𝙤 𝙥𝙧𝙚𝙫𝙞𝙤𝙪𝙨 𝙥𝙤𝙨𝙩
These are frontal and oblique X-rays of the
right foot of a skeletally immature patient.
• There are no patient identifiable data on the
X-rays. Confirmation of the patient’s name and date of birth, and the date and time when the X-rays were performed is required before making any further assessment.
• The X-rays are technically adequate, with no important areas cut off.
• A fracture is visible at 5th metatarsal diaphysis.
• The soft tissues are unremarkable.

In summery-
These X-rays show a right foot 5th metatarsal head fracture.

28/12/2023

A 14 year old boy presents to physiotherapy OPD with pain over the lateral aspect of his foot following an inversion injury. He is tender over the base of the 5th metatarsal but able to weight bear. X-rays have been performed for further assessment.

What could be the diagnosis?
Comment your findings and opinion.

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